Effect of physiotherapy and dynamic orthosis in hemophilia patient with advanced elbow arthropathy: a case report
Öz
Hemophilia is a bleeding disorder due to lack of
clotting factors and its most prominent feature is intra-articular bleedings
lead to hemophilic arthropathy (HA). HA is most commonly seen in the knee,
elbow and ankle joints, respectively. Conservative approaches gain importance
as success of surgical treatment options is low in the elbow HA. Thus, this
study was carried out to demonstrate the effects of physiotherapy and dynamic
orthosis (DO) in advanced elbow HA. In elbow assessment of 24 year old male
patient with elbow HA, goniometer, digital dynamometer, Visual Analog Scale,
Hemophilia Joint Health Scoring-Elbow Score, Quick-Disabilities of the Arm
Shoulder and Hand questionnaire and Hospital for Special Surgery Scoring System
were used. In the physiotherapy, manual therapy and upper extremity
strengthening exercise were applied the 3 times in a week for 5 weeks totally
15 sessions. Elbow extension was measured in 10th sessions and DO was given to
patient for wear at home during 6-8 hours. The treatment was completed at 15th
session and all measurements were repeated. As a result of these treatments
decreased the flexion contracture from 45 to 25 degrees, reduced the pain
level, increased the joint health status, muscle strength, ROM and
functionality. We observed that use of DO improved ROM but caused some minor
complications. Thus it has been concluded that DO is beneficial in this patient
but controlled studies are needed for more accurate result whereas
physiotherapy consist of manual therapy and strengthening exercise are
beneficial without any complications in treatment of advanced elbow HA.
Kaynakça
- 1. Srivastava A, Brewer AK, Mauser-Bunschoten EP, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19:1-47.
- 2. Heim M, Beeton K, Blamey G, et al. Management of the elbow joint. Haemophilia. 2012;18:101-104.
- 3. Rodriguez-Merchan EC. Musculoskeletal complications of hemophilia. HSS J. 2010;6:37-42.
- 4. Carcao M, Hilliard P, Escobar MA, et al. Optimising musculoskeletal care for patients with haemophilia. Eur J Haematol. 2015;95:11-21.
- 5. Rodriguez-Merchan EC. Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med. 2012;2012:201271.
- 6. Hilliard P, Funk S, Zourikian N, et al. Hemophilia joint health score reliability study. Haemophilia. 2006;12:518-525.
- 7. Sun J, Hilliard PE, Feldman BM, et al. Chinese hemophilia joint health score 2.1 reliability study. Haemophilia. 2014;20:435-440.
- 8. Feldman BM, Funk SM, Bergstrom BM, et al. Validation of a new pediatric joint scoring system from the International Hemophilia Prophylaxis Study Group: validity of the haemophilia joint health score. Arthritis Care Res (Hoboken). 2011;63:223-230.
- 9. Poonnoose PM, Hilliard P, Doria AS, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925-933.
- 10. Dale TM, Saucedo JM, Rodriguez-Merchan EC. Total elbow arthroplasty in haemophilia. Haemophilia. 2018;24:548-556.
- 11. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis. 2018;13:151.
- 12. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014;20:71-78.
- 13. Cuesta-Barriuso R, Trelles-Martínez RO. Manual therapy in the treatment of patients with hemophilia B and inhibitor. BMC Musculoskelet Disord. 2018;19:26.
- 14. De la Corte-Rodriguez H, Rodriguez-Merchan EC. The current role of orthoses intreating haemophilic arthropathy. Haemophilia. 2015;21:723-730. 15. Solimeno L, Goddard N, Pasta G, et al. Management of arthrofibrosis in haemophilic arthropathy. Haemophilia. 2010;16:115-120.
- 16. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76:248-259.
- 17. Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil. 2006;17:99-107.
- 18. Inglis AE, Pellicci PM. Total elbow replacement. J Bone Joint Surg. 1980;62:1252-1258.
- 19. Figgie MP, Inglis AE, Mow CS, et al. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg Am. 1989;71:513-250.
- 20. Negrier C, Seuser A, Forsyth A, et al. The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity. Haemophilia. 2013;19:487-498
İleri evre dirsek artropatisi olan hemofili hastasında manuel terapi ve dinamik ortezin etkisi: olgu sunumu
Öz
Hemofili,
pıhtılaşma faktörlerinin eksikliğine bağlı bir kanama bozukluğudur ve bu
hastalığın en belirgin özelliği hemofilik artropatiye (HA) neden olan eklem içi
kanamalardır. HA, sırasıyla en sık diz,
dirsek ve ayak bileği eklemlerinde görülür. Dirsek HA’sında cerrahi tedavi
seçeneklerinin başarısı düşük olduğundan konservatif yaklaşımlar önem kazanmaktadır.
Bu çalışma, ileri evre dirsek HA’sında fizyoterapi tedavisinin ve dinamik
ortezin (DO) etkisini göstermek amacıyla yapıldı. Dirsek HA tanılı 24 yaşındaki
erkek hastanın dirsek ekleminin değerlendirmesinde, gonyometre, dijital
dinamometre, Vizüel Analog Skala, Hemofili Eklem Sağlığı Skorlaması-Dirsek
Puanı, Kol-Omuz ve El Sorunları Hızlı Anketi ve Hospital for Special Surgery
Skorlama Sistemi kullanıldı. Fizyoterapi tedavisinde, 5 hafta boyunca haftada 3
gün (toplamda 15 seans) manuel terapi ve üst ekstremite kuvvetlendirme
egzersizleri uygulandı. 10. Seansın sonunda dirsek ekstansiyonu ölçüldü ve
hastaya evde 6-8 saat süreyle takması için dirsek DO’su verildi. 15 seansın
sonunda tedavi sonlandırıldı ve ölçümler tekrar edildi. Sonuçta, uygulanan tedavilerin
hastanın 40° olan fleksiyon kontraktürünü 25°’ye gerilettiği; ağrıyı azalttığı,
eklem hareket açıklığını, kas gücünü, eklem sağlığını ve fonksiyonelliği
geliştirdiği görüldü. DO’nun EHA’yı geliştirdiği ancak bazı minör
komplikasyonlara yol açtığı gözlemlendi. Bu nedenle, ileri düzey dirsek HA’nın
tedavisinde DO’nun faydalı olduğu, ancak daha kesin sonuçlar için kontrollü
çalışmalara ihtiyaç olduğu buna karşılık manuel terapi ve kuvvetlendirme
egzersizlerinden oluşan fizyoterapi tedavisinin herhangi bir komplikasyona yol
açmadan yararlı olduğu sonucuna varıldı.
Anahtar Kelimeler
Hemofili hemofilik artropati dirsek artropatisi manuel terapi dinamik ortez egzersiz
Kaynakça
- 1. Srivastava A, Brewer AK, Mauser-Bunschoten EP, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19:1-47.
- 2. Heim M, Beeton K, Blamey G, et al. Management of the elbow joint. Haemophilia. 2012;18:101-104.
- 3. Rodriguez-Merchan EC. Musculoskeletal complications of hemophilia. HSS J. 2010;6:37-42.
- 4. Carcao M, Hilliard P, Escobar MA, et al. Optimising musculoskeletal care for patients with haemophilia. Eur J Haematol. 2015;95:11-21.
- 5. Rodriguez-Merchan EC. Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med. 2012;2012:201271.
- 6. Hilliard P, Funk S, Zourikian N, et al. Hemophilia joint health score reliability study. Haemophilia. 2006;12:518-525.
- 7. Sun J, Hilliard PE, Feldman BM, et al. Chinese hemophilia joint health score 2.1 reliability study. Haemophilia. 2014;20:435-440.
- 8. Feldman BM, Funk SM, Bergstrom BM, et al. Validation of a new pediatric joint scoring system from the International Hemophilia Prophylaxis Study Group: validity of the haemophilia joint health score. Arthritis Care Res (Hoboken). 2011;63:223-230.
- 9. Poonnoose PM, Hilliard P, Doria AS, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925-933.
- 10. Dale TM, Saucedo JM, Rodriguez-Merchan EC. Total elbow arthroplasty in haemophilia. Haemophilia. 2018;24:548-556.
- 11. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis. 2018;13:151.
- 12. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014;20:71-78.
- 13. Cuesta-Barriuso R, Trelles-Martínez RO. Manual therapy in the treatment of patients with hemophilia B and inhibitor. BMC Musculoskelet Disord. 2018;19:26.
- 14. De la Corte-Rodriguez H, Rodriguez-Merchan EC. The current role of orthoses intreating haemophilic arthropathy. Haemophilia. 2015;21:723-730. 15. Solimeno L, Goddard N, Pasta G, et al. Management of arthrofibrosis in haemophilic arthropathy. Haemophilia. 2010;16:115-120.
- 16. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76:248-259.
- 17. Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil. 2006;17:99-107.
- 18. Inglis AE, Pellicci PM. Total elbow replacement. J Bone Joint Surg. 1980;62:1252-1258.
- 19. Figgie MP, Inglis AE, Mow CS, et al. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg Am. 1989;71:513-250.
- 20. Negrier C, Seuser A, Forsyth A, et al. The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity. Haemophilia. 2013;19:487-498
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Case Reports |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Ağustos 2019 |
| Gönderilme Tarihi | 28 Kasım 2018 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 6 Sayı: 2 |
